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Dr.Samar Community
:
l
Anoroxia nervosa.
l
Bulimia nervosa.
Anorixa nervosa:
z
99% female.
z
Weight loss, BMI: < 17.5.
z
Avoidance of high calorie foods.
z
Excessive exercise.
z
Distortion of body image ( terrified of weight agin).
z
Amenorrhea for at least 3 months.
z
Anxiety and depression.
z
Dewry hair on back, forearm (lanugo)
Aetiology:
x Unknown: genetic & enviromental factors including: social pressure on women to be
thin.
x In adolescence female.
Metabolic:
1- Uremia.
2- Renal calculi.
3- Impair bone mineralization, osteoporosis.
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Gastrointeastinal:
1. Constipation.
2. Abnormal liver function test.
Diagnosis:
v
Adolescence.
v
Famale.
v
Differential diagnosis:
1. Psychiatic disorder.
2. Inflamatory bowel.
3. Malabsorption.
4. Hypopitutarism.
5. Cancer.
Management & prognosis:
w Ensure patients physical well being.
w Help to increase body weight.
w Good theraputic relationship.
w Treatment: outpatients basis.
w Inpatients:
1. If more than 65% of normal.
2. Risk of death.
3. There is medical comlication.
4. Suicide.
5. Psychological treatment, family therapy.
Treatment:
G
Increase weight: 1 – 3Ib/wk.
G
1500 kcal/day to 3000 – 3600.
G
Moderate activity.
G
Common cause of death suicide.
G
They are very clover, wearing alot of clothes, put coins in their packets.
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Bulimia nervosa:
k Usually at normal body weight.
k Morbid fear pf fatness.
k Recurrent eating binges follow by correstive meature: self induce vomiting.
h Later in adolescence.
h Ritted teeth from vomiting.
h Callouses on knuckless (Russel's sign)
h Paroitid galnds enlargment.
h Dental oesophogeal consequences of repeated vomiting.
h Electrolyte disturbance.
h Cardial, arrythmia, renal problem.
Treatment:
g
Psychcotherapy.
g
Fluxetine.
g
Not carry mortality.
Eating disorder:
j
Anoroxia weight loss at least 15% of total body weight ,avoid
high caloring diet, distrubtion body image
Amorrhea 3 months.
j
Bulimia binge, eating, A lack of safe control over,
Induce vomiting, Normal weight.